Provider Demographics
NPI:1093781486
Name:NGUYEN, THIEU VAN (MD)
Entity Type:Individual
Prefix:DR
First Name:THIEU
Middle Name:VAN
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2658
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34230
Mailing Address - Country:US
Mailing Address - Phone:941-861-2900
Mailing Address - Fax:941-861-2868
Practice Address - Street 1:2200 RINGLING BOULEVARD
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34237
Practice Address - Country:US
Practice Address - Phone:941-861-2900
Practice Address - Fax:941-861-2868
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME46204207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL049257400Medicaid
03855XMedicare ID - Type Unspecified
FL049257400Medicaid